Meibomian gland dysfunction: symptoms, treatment and how long it lasts

The meibomian glands are small oil glands set in the edge of the upper and lower eyelids, behind the eyelashes. Their oil spreads across the tear film and slows evaporation of the tears. In meibomian gland dysfunction the glands do not release oil properly. They may be blocked or inflamed, which leads to irritation of the eyelid margins and an unstable tear film.

NICE CKS describes blepharitis as inflammation of the margin of the eyelids and divides it into anterior, posterior and mixed types. Posterior blepharitis affects the posterior lid margin, which contains the meibomian glands, and usually results from meibomian gland dysfunction. The NHS lists the glands inside the eyelids not producing enough oil as one of the causes of blepharitis, alongside bacteria that live on the skin and skin conditions such as seborrhoeic dermatitis.

NICE CKS divides blepharitis, inflammation of the eyelid margin, into three patterns. Meibomian gland dysfunction is the usual cause of the posterior type, which is why the two terms are often used interchangeably.

The NHS says blepharitis can often be treated by washing the eyelids every day, and that you should continue to clean your eyelids even if symptoms clear up. Cambridge University Hospitals describes lid hygiene as a combination of warm compresses, lid massage and lid scrubs, and says treatment for both types of blepharitis is regular cleaning of the eyelids for as long as symptoms persist.

The Cambridge instructions are to place warm water in a small bowl, soak a clean flannel or eye pad, and place it over closed eyes for around 5 to 10 minutes, massaging the margin of the lids towards the lashes, then wiping away any particles. It suggests reheating the flannel in warm water so that it does not go cold, and repeating every morning and evening. The NHS gives a similar routine: a warm flannel on the closed eyelid for 5 to 10 minutes, gentle massage for around 30 seconds, then cleaning with cotton wool or a cotton bud, using a small amount of baby shampoo in water if it helps.

Alternatives that some patients find useful, according to Cambridge, include a microwaveable eyebag followed by massage, a cotton bud dipped in diluted baby shampoo (1 part to 10 parts water), and commercially available eyelid-cleaning solutions or lid wipes. The NHS says a pharmacist can suggest eye pads, wipes and eyedrops. For dry eyes the NHS stresses the water should be warm, not hot, and that the warmth makes the oil produced by the glands more runny, while gentle massage pushes the oils out.

• Wash your hands before touching the eyelids.

• Do not wear contact lenses or eye make-up (especially eyeliner and mascara) while you have symptoms, per NHS advice.

• Take screen breaks and rest your eyes, and avoid very smoky, dry, dusty or air-conditioned environments, per NHS dry eye advice.

• Do not stop a prescribed medicine without medical advice, even if you think it may be affecting your eyes.

The NHS lists sore eyelids, itchy eyes, a gritty feeling in the eyes, flakes or crusts around the roots of the eyelashes and eyelids sticking together in the morning as symptoms of blepharitis, and says the symptoms often come and go. NICE CKS adds burning, itching and crusting of the eyelids, usually in both eyes and typically worse in the morning.

Because the tear film is affected, MGD often overlaps with dry eye. The NHS lists itchy, sore, gritty, red, blurry, light-sensitive or more watery than normal eyes as the symptoms of dry eyes. Cambridge University Hospitals notes that some patients may not experience any symptoms at all.

NICE CKS emphasises explaining the chronic nature of the condition and the need for ongoing treatment. Cambridge University Hospitals says blepharitis is an ongoing condition that is likely to recur, and that you should restart the eyelid hygiene routine if symptoms return. The NHS says blepharitis is not usually serious and cannot be spread to other people. Managing contributory conditions such as rosacea or seborrhoeic dermatitis, and general dry eye measures, are often part of the longer-term plan.

NICE CKS lists stye and chalazion formation, chronic conjunctivitis and contact lens intolerance among the complications of blepharitis. Less frequently, blepharitis can result in permanent changes to the eyelids and visual problems due to keratopathy and corneal ulceration. The NHS says that if blepharitis has caused other problems, such as a lump of fluid under the skin (cyst), antibiotic eye drops or tablets may be recommended.

The NHS says to see a GP if blepharitis symptoms do not improve or get worse. For dry eyes it advises seeing an optician or GP if you still have symptoms after trying home treatments for a few weeks or if there is any change in the shape of your eyelids.

Some symptoms are different from ordinary blepharitis. The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have pain in your eyes, changes to your vision such as vision loss or blurred vision, or very red eyes. For dry eyes it adds a red eye if you wear contact lenses, because you could have an eye infection. It advises calling 999 or going to A&E for any change in sight such as wavy lines, flashing or loss of vision, or if it hurts to look at light.

NICE CKS says the diagnosis of blepharitis is usually based on history and clinical examination and that investigations are not routinely required. If the picture is atypical, or other eye symptoms are present, the NHS says the GP may refer you to an eye specialist (ophthalmologist).

NICE CKS lists offering pharmacological treatment, such as topical antibiotics, when appropriate, managing associated conditions to reduce recurrence, and identifying people who need specialist management. The NHS says a GP might suggest an antibiotic cream or ointment rubbed onto the eyelid if blepharitis does not clear up after cleaning the eyelids regularly. If blepharitis is severe or you have other eye symptoms, a GP may refer you to an ophthalmologist.

Eyelid hygiene advice is usually given by GPs, pharmacists and opticians. Some NHS opticians provide care for certain eye conditions, and hospital eye clinics see more complex or persistent cases. Private optometry and eye clinics may offer additional assessments or treatments of the glands. The self-care routine described above is the same either way, so ask any provider what evidence supports a suggested procedure and how it fits with daily lid care.